| |
|
Rate 9 if not
known |
Rate |
|
1 |
Overactive, aggressive, disruptive behaviour |
0 1 2 3 4 |
|
|
2 |
Non-accidental self-injury |
0 1 2 3 4 |
|
|
3 |
Problem-drinking or drug-taking |
0 1 2 3 4 |
|
|
4 |
Cognitive problems |
0 1 2 3 4 |
|
|
5 |
Physical illness or disability problems |
0 1 2 3 4 |
|
|
6 |
Problems with hallucinations and delusions |
0 1 2 3 4 |
|
|
7 |
Problems with depressed mood |
0 1 2 3 4 |
|
|
(Specify disorder A,B,C,D,E,F,G,H,I, or J) |
|
8 |
Other mental & behavioural problems |
0 1 2 3 4 |
|
|
9 |
Problems with relationships |
0 1 2 3 4 |
|
|
10 |
Problems with activities of daily living |
0 1 2 3 4 |
|
|
11 |
Problems with living conditions |
0 1 2 3 4 |
|
|
12 |
Problems with occupation and activities |
0 1 2 3 4 |
|
|
|
Total |
0-48 |
|